NUR 209 Exam 2 (Cardiovascular)

Prep U A 45-year-old client with a history of hypertension asks the nurse about starting an exercise program. When counseling this client, which suggestion would be most appropriate? "Try using one of those energy drinks to help you get through the exercise program." "Be sure to have a physical exam before you start any intensive exercise program." "Check out the local fitness center for some help in getting really active." "It is also a good idea to visit a dietitian if you are starting an exercise program."

"Be sure to have a physical exam before you start any intensive exercise program."

Prep U A nurse is evaluating a client's blood pressure. On the past several visits to the clinic, the client's blood pressure readings were 134/86 mm Hg, 128/82 mm Hg and 130/84 mm Hg. Today, the client's blood pressure is 136/88 mm Hg. The nurse would classify this as: high BP stage 2. high BP stage 1. normal. prehypertension.

prehypertension Explanation: The client's blood pressure readings fall within the category of prehypertension (120-139 mm Hg systolic or 80-89 mm Hg diastolic). Normal ranges are below 120/80 mm Hg

Flow of blood through the heart

superior/ inferior vena cava >>right atrium>> tricuspid valve >> right ventricle >> pulmonic valve >> lungs >> left atrium >> mitral (bicuspid) vale >> rt. ventricle >> aortic valve >> aorta

What positions are acceptable for auscultating the heart?

supine, sitting up, or laying on lateral left side

Modifiable risk factors

high BP smoking use high cholesterol obesity diabetes stress

Age and lifestyle factors may contribute to the process of calcification, fatty degeneration, and diminished elasticity of the blood resulting in ...

higher BP and decreased cardiac output

If the left side of the heart is sluggish/weak , what will you see?

if the left side of the heart is sluggish/weak then you see pulmonary edema (crackles) because the left side of the heart takes oxygenated blood from the lungs. You also see the heart working harder to supply blood to the aorta and carotid arteries

As part of the assessment of the peripheral vascular system, inspection includes..

you're looking at the upper and lower extremities look for: symmetry cyanosis/ acrocyanosis nail beds: clubbing edema variscosities (which means a weakened vein that cant withstand pressure) ulcerations or lesions

As part of the assessment of the peripheral vascular system, palpation includes..

you're looking at the upper and lower extremities palpate the brachial, radial, pedal, popliteal arteries use back of hand to feel the temperature over these arteries squeeze fingers for capillary refil

Prep U A nurse is teaching a client with heart disease about exercising and signs of overexertion. The nurse determines that additional education is needed if the client states: "I should wait at least an hour after eating before exercising." "I need to call the doctor if it feels like my heart is racing." "I need to start my routine with my warm-up exercises." "I should stop exercising if my pulse is below my target zone."

"I should stop exercising if my pulse is below my target zone." Explanation:For the client, the goal of the exercise program is to achieve the target heart rate. The client should stop exercising if his pulse rate exceeds his target zone.

Prep U The nurse is applying antiembolism stockings on a client. The client asks, "Why are you putting powder on my legs?" Which response by the nurse would be most appropriate? "The powder helps to make sure your legs are dry for easier application." "The powder helps to ensure that the stockings fit properly." "It helps to keep the legs warmer when wearing the stockings." "It helps to prevent any pressure areas from developing."

"The powder helps to make sure your legs are dry for easier application."

Prep U A client is scheduled for a cardiac catheterization. When explaining the purpose of this test to the client, which statement would be appropriate for the nurse to include in the education? "It helps identify any problems with electrical conduction in your heart." "The test is used to check how thick your heart muscle wall is." "The test can show any narrowing of the arteries in your heart." "It helps to see how your heart responds to stress."

"The test can show any narrowing of the arteries in your heart."

Prep U The nurse is reviewing the medical record of a client who has returned to the clinic for a follow-up visit. On several previous visits, the client's blood pressure readings were as follows: 124/80 mm Hg; 132/86 mm Hg; 130/88 mm Hg. The client's blood pressure today is 128/82 mm Hg. Which statement by the nurse best reflects appropriate education for this client? "Your blood pressure is normal. Keep up the good work!" "Your blood pressure is moderately elevated. This is known as hypertension." "Your blood pressure is significantly elevated. This is known as a hypertensive crisis." "Your blood pressure is slightly elevated. This is known as prehypertension."

"Your blood pressure is slightly elevated. This is known as prehypertension." Rationale: The patient's blood pressure readings fall within the prehypertension category, with a systolic blood pressure between 120 to 139 mm Hg and a diastolic blood pressure between 80 to 89 mm Hg.

Prep U A client with angina is prescribed sublingual nitroglycerin. After teaching the client about this medication, the nurse determines that additional education is needed when the client states: "I should feel a tingling under my tongue when I use it." "I should carry the medicine with me at all times." "I can store the medicine on my counter in a clear glass container." "I need to check the expiration date so I refill the medicine on time."

- "I can store the medicine on my counter in a clear glass container." Rationale: In clients with a history of pain, nitroglycerin should always be available so that it can be quickly administered if chest pain occurs.

During palpation of the carotid artery, you feel a thrill. What does this mean?

you feel this if you hear a bruit. it feels like a vibration

Prep U A nurse is assessing the skin of a client with chronically impaired perfusion of the lower extremities. Which findings would the nurse most likely assess? Select all that apply. Skin ulceration Rubor Thin, pliable nails Shiny, dry skin Hair loss in the affected area

- Hair loss in the affected area - Shiny, dry skin - Skin ulceration

Pulse grading scale

0 = Absent +1 = Palpable but thready and weak 2+ = Normal; Easily palpable 3+ = Full 4+ = Bounding/Aneurysmal

Prep U A nurse has received certification in basic life support. The nurse would plan to be recertified in: 3 years 4 years 1 year 2 years

2 years

What length is normal jugular vein distension?

3 cm at 45 degrees

Pitting edema grading scale

4+ indention of 6-8 mm and dent stays for 2-5 minutes 3+ indentation of 4-6mm and dent stays for 1 minute 2+ indentation of 2-4 mm and disappears in 10-15 sec 1+ indentation barely detectable. its about 2mm but dent goes away almost immediately

Prep U A nurse is providing care to a client with heart failure with a nursing diagnosis of Fluid Volume Excess. As part of the nursing plan of care, the nurse weighs the client every morning before breakfast. The client's weight yesterday was 75 kg. Which weight, if obtained today, would the nurse report to the health care provider? 74.0 kg 76.5 kg 74.8 kg 75.7 kg

76.5 kg because if you are in fluid overload, you gain 1 kg or more every day

Normal blood pressure is

90-120 systole 60-80 diastole

Prep U A nurse is assessing the heart rate of a newborn. Which finding would the nurse immediately report to the physician? 145 beats per minute 160 beats per minute 98 beats per minute 132 beats per minute

98 beats per minute Explanation: normal infant heart rate is 130-160 BPM

Prep U The nurse is caring for several clients on the unit. Which client should the nurse prioritize interventions because of possible formation of thrombi? A 32-year-old client preparing for discharge after surgery for a fractured fibula An unconscious 29-year-old client who suffered a head injury in an accident A 58-year-old client who underwent an emergent appendectomy A 28-year-old client who is in traction for a fractured right femur

An unconscious 29-year-old client who suffered a head injury in an accident Rationale: The immobile and unconscious client has the highest risk for developing a thrombi due to lack of movement and the nurse will need to ensure the client is provided proper care to help eliminate this potential risk.

Prep U The nurse is assessing a client's edematous lower extremities and notes the absence of pitting. The area appears shiny, warm, and moist; it is hard on palpation. The nurse documents this finding as which type of edema? 4+ 3+ Brawny 2+

Brawny Explanation:Brawny edema is characterized by fluid being no longer displaced secondary to excessive interstitial fluid accumulation.

Prep U A nursing instructor is developing a class presentation about reasons people with cardiovascular problems seek medical care. Which of the following would the instructor include as the most common reason? Lower extremity swelling Persistent cough Chest pain Hypertension

Chest pain Explanation:Although a person with cardiovascular dysfunction may have hypertension, lower extremity swelling, or cough, pain or discomfort in the chest is the most common reason people with cardiovascular dysfunction seek medical care.

Blood Pressure equation

Cardiac Output (CO) x Peripheral Vascular Resistance (PVR)

Prep U A 43-year-old woman was admitted to the hospital status post chest pain and cardiac ischemia. The nurse is reviewing her list of daily medications. What might actually increase the client's risk for cardiovascular problems? Select all that apply. Cold medication Diuretic Statin Oral contraceptives

Cold medication- because they have decongestants which makes your blood vessels constrict and thus makes blood pressure and heart rate go up Diuretic Oral contraceptives

Prep U During a home care visit, a nurse completes a physical assessment and suspects that the client is experiencing heart failure. What would lead the nurse to suspect this? Pink skin Dependent edema Flattened neck veins Clubbed fingers

Dependent edema Rationale: Dependent edema and engorged neck veins suggest heart failure or inefficient pumping ability of the heart. Pink skin would be considered a normal finding. Engorged neck veins imply inefficient right-sided heart pumping. Clubbed fingers are associated with oxygenation problems resulting from respiratory or cardiovascular disease.

Prep U Which of the following is a noninvasive procedure assisting the nurse in cardiovascular care? Electrocardiography Pulmonary artery monitoring Swan-Ganz catheterization Cardiac output determination

Electrocardiography Explanation:Noninvasive heart monitoring involves electrocardiography and cardiac monitoring. Invasive techniques, such as pulmonary artery monitoring, Swan-Ganz catheterization, cardiac output determination, and cardiac support via an intraaortic balloon pump (IABP), typically are used by trained critical care personnel to provide additional monitoring and support.

Prep U The nurse is assessing a 54-year-old client with a history of alcohol use disorder, who presents with a strong odor of alcohol on the breath, slurred speech, and poor coordination. Which finding on the assessment will the nurse anticipate? Slightly elevated temperature Elevated blood pressure No bowel sounds Hyperactivity

Elevated blood pressure

Prep U After reviewing information about the structure of the heart, nursing students demonstrate understanding of the information when they identify which of the following as the part that attaches the heart to the diaphragm and sternal wall? Septum Epicardium Myocardium Endocardium

Epicardium

T/F: Pedal pulse is affected by edema or cyanosis

FALSE it is not affected by either of these

Is the following statement true or false? When the patient is in an upright position, the increased volume of blood entering the atria increases stroke volume and workload of the heart

False it's when you're laying flat that this happens. You increase the amount of blood in the trunk area when you lay flat so the heart works harder

The ventricles eject blood during the period of heart contraction called diastole. FALSE TRUE

False- its called systole

Prep U A client with cardiovascular dysfunction is prescribed a diuretic. Which nursing diagnosis would most likely apply? Decreased Cardiac Output Activity Intolerance Pain Fluid Volume Excess

Fluid Volume Excess

Chronically impaired perfusion of extremities can cause _________ perception of the sensation of heat.

decreased

Prep U A nurse is preparing to administer a prescribed medication as prophylactic therapy for deep vein thrombosis. What would the nurse most likely give? Amiodarone Digoxin Heparin Nitroglycerin

Heparin Explanation:Heparin is an anticoagulant that may be ordered as prophylaxis for deep vein thrombosis. Digoxin is a cardiac glycoside used to increase cardiac contractility and decrease heart rate. Nitroglycerine is a drug used to relieve angina pain. Amiodarone is a drug used to regulate heart rhythm.

Peripheral edema can _______ blood flow to the tissues.

Impede (delay or stop)

What is the sound we hear when we listen to the heartbeat?

Its the valves closing

Prep U The nurse is assessing a client who comes to the urgent care clinic with the general report, "I just do not feel good." Which action should the nurse prioritize when noting the client's blood pressure is 198/130 mm Hg? Notify the health care provider immediately Document reading in the medical record Attach a blood pressure monitor to the client Recheck the blood pressure after 5 minutes

Notify the health care provider immediately

Prep U A client is at risk for thrombus formation following surgery. Which action should the nurse take to assess for this risk? Auscultate the lungs Observe the legs for redness Measure the blood pressure Measure the pulse at the carotid artery

Observe the legs for redness Explanation: Thrombi can form in any blood vessel, but they are most likely to form in the deep veins of the legs. The nurse should report any redness or reports of pain or swelling in the legs.

Prep U The nurse is conducting an assessment on a 57-year-old male who presents to the emergency department with reports of chest discomfort, blacking-out, swollen and sore ankles, shortness of breath when lies down, and blood pressure 138/92 mm Hg. Which action should the nurse prioritize? Complete a comprehensive assessment Obtain 12-lead electrocardiogram (ECG) Attach blood pressure monitor Ask about pain level

Obtain 12-lead electrocardiogram (ECG)

What is this term called? In some cases, the valve doesn't close all the way and as a result, blood can flow backwards rather than being pumped out of the heart. The left ventricle has to work harder to pump the extra blood that has come back into the heart and, over time, it can thicken

Regurgitation

For physical assessment of this system, you do an inspection first which entails...

checking for general behavior, cognition, LOC dyspnea, orthopnea, cough skin >> cyanosis or acrocyanosis (mottling) (Cyanosis is most easily seen where the skin is thin, such as the lips, mouth, earlobes and fingernails. Acrocyanosis refers to cyanosis found in the extremities, particularly the palms of the hands and the soles of the feet) jugular vein distension (when you see this, they usually have peripheral edema)

Electric impulse of the heart

SA node >> AV node >> bundle of His >> rt and left bundle branches >> purkinje fibers

Prep U Upon entering a client's room, the client tells the nurse, "I'm having some really strong pain in my chest." The nurse intervenes immediately, placing the client in which position? Sitting Standing upright Flat with legs raised 20 to 30 degrees Supine

Sitting Explanation:The nurse should make the client comfortable in a sitting position. A supine position inhibits full chest expansion and limits gas exchange in the lung, so this position should be avoided. Since the heart works harder in the supine position than in the upright position, the supine position is not recommended. The hypotensive client is positioned with legs elevated 20 to 30 degrees.

Cardiac Output

Stroke Volume (SV) x Heart Rate (HR)

The apex of the heart is the ____ of the heart and thats where you hear ____ sounds

The base of the heart is the bottom of the heart and thats where you hear S1 sounds

The base of the heart is the ____ of the heart and thats where you hear ____ sounds

The base of the heart is the top of the heart and thats where you hear S2 sounds

What happens during the U wave?

This is when the atria is filling again

T/F: Pain that changes with deep breathing or movement is unlikely to be related to cardia ischemia

True this is probably due to a musculoskeletal issue

T/F: Contraction of the leg muscles help bring blood back up to the heart

True Which is why if someone isn't moving their legs, they experience venous stasis or clots Remember, venous clots can end up in your lungs because venous=veins=to the right side of the heart = rt. side of the heart goes to the lungs= pulmonary embolism

To lift an object, patients should be warned against using the maneuver ___________ , which occurs when bearing down.

Valsalva

Prep U When describing the normal cardiac cycle, which of the following would a nursing instructor describe as occurring during systole? Ventricles eject blood. Chambers fill with blood. Heart muscle relaxes. Impulse is generated.

Ventricles eject blood.

Compare these assessment questions to the 8 critical characteristics learned earlier "What does it feel like? (pressure/ weight on chest)"

character or quality

If someone has clots or stagnant bloodflow, that means its coming from which side of the body? What does it mean?

When someone has clots or stagnant bloodflow, thats coming from the right side of the body. It means the right side of the heart is sluggish/weak. So since the right side of the heart takes is responsible for taking blood from the right side of the body, and this right side is weak, it'll causes edema in the feet or legs. It can also cause distension in the rt. jugular vein

Compare these assessment questions to the 8 critical characteristics learned earlier "Does anything you do make it better or worse?"

aggravating/ relief factors

Compare these assessment questions to the 8 critical characteristics learned earlier "Does the pain increase with deep breathing or movement?"

aggravating/ relief factors

What are the 4 places to listen to when auscultating the heart?

aortic area -- 2nd intercostal to rt. of sternum pulmonic area -- 2nd intercostal on left of sternum tricuspid area -- 5th intercostal on left of sternum mitral area -- 5th intercostal left mid clavicular

Pulce deficit calculation

apical pulse- radial pulse

Subjective assessment questions to ask the patient (dysfunction identification)

ask if they have any chest or leg pain and the activity level associated with the pain stroke screening

Compare these assessment questions to the 8 critical characteristics learned earlier "Do you feel any other symptoms?"

associated factors

Where is the apical impulse felt?

at the left 5th intercostal space

What happens during the P wave?

atria are contracting and ventricles are filling

Subjective assessment questions to ask the patient (risk identification)

do you have a family history of heart disease? are you on any current meds?

Sometimes veins have a hard time bringing blood to the heart so you may see..

edema in the feet with: thickened and leathery skin ( sign of a vascular problem)

Pitting edema

edema that retains an imprint when touched this happens BILATERALLY this is a sign of fluid overload and its a cardiac condition

Drinkers of caffeinated coffee and cola usually have lower heart rates and blood pressures than do those who drink decaffeinated beverages. TRUE FALSE

false they usually have higher heart rates and blood pressures

Blood pressure should be measured annually beginning in the newborn period. FALSE TRUE

false annually is too long of a wait

Nonmodifiable risk factors for heart issues

family history gender age african american (have higher risk of cardiovascular diseases)

Cramping in the legs from walking can mean

ischemic pain from lack of bloodflow to the leg (this is an issue with the ARTERIES !! Remember arteries go to the limbs (away from the heart))

In teaching a patient about nitroglycerin use, it should be noted that this medication breaks down over time and with exposure to _______

light

Compare these assessment questions to the 8 critical characteristics learned earlier "Does the pain go anywhere else? (arms/neck)"

location and radiation OR associating factors

Prep U A nurse is assigned to care for a client with a terminal cardiovascular illness. When developing the client's plan of care, which outcome would the nurse identify as most realistic for this client? adaptation to living with limitations maintenance of adequate comfort acceptance of changes in lifestyle recovery from the cardiovascular problem

maintenance of adequate comfort Rationale: The realistic outcome for a client with terminal cardiovascular disease is maintenance of adequate comfort and acceptance of impending death.Realistic outcomes for the client with chronic cardiovascular disease focus on helping the client to live within limitations imposed by the disease and to improve acceptance of changes in lifestyle and self-concept. Outcomes pertinent to the client who is admitted with an acute problem focus on recovery from the cardiovascular problem without residual complications.

You take apical heart rate over which valve?

mitral (bicuspid) valve

The flow of blood through the body tissues is called tissue ______

perfusion

Implementation methods for venous insufficiency

prevent venous stasis by: avoiding constrictions (crossing legs/ tight clothes) assist in leg exercises (flexion and extension) anti-embolism stockings (stays on for 8-9 hrs) pneumatic compression devices impulse foot pumps (not that effective) anticoagulation prophylaxis (an SQ injection) with venous insufficiency you want to try to elevate the legs to bring blood to the heart fluid restriction (if PT is on IV fluids, minus that #) do daily weighs (if PT gains 1kg per day, its a sign of fluid overload)

Compare these assessment questions to the 8 critical characteristics learned earlier "How bad is it? (scale of 1-10)"

quantity or severity

Systole is the indirect pressure of which ventricle contraction?

right ventricle contraction

Compare these assessment questions to the 8 critical characteristics learned earlier "What were you doing when the pain began?"

setting

Prep U A nurse is providing care to a client with high blood pressure who is at risk for decreased cerebral tissue perfusion. The nurse would be alert for: appropriate responses. ability to follow directions. slowed speech. orientation to time.

slowed speech.

What will happen to the ventricle if blood is trying to leave the ventricles but the valve doesn't open all the way?

the ventricle will strain

What happens during the T wave?

the ventricles are relaxing

What happens during the QRS wave?

the ventricles are squeezing

Diastole is when

the ventricles relax and start filling

Metabolic Syndrome (Syndrome X)

this is a metabolic issue related to glucose and fat metabolism that increases the risk for cardiovascular disease factors found for this disease: -triglycerides > 150 in men -HDL <50 for women and <40 for men -abdominal waist circumference of >40 inches for men and > 35 inches for women -fasting glucose level of > 110 mg/dL. Normal levels are between 60-110 so if you're fasting and its that high, its a problem

During auscultation of the carotid artery, you hear a bruit.. what does this mean?

this is an abnormal swooshing sound and its a sign of plaque build up

Tell me about venous insufficiency

this is decreased venous return to the heart causing pressure in the veins risk factors are DVT/immobility/obesity/ pregnancy characteristics are aching pain in lower extremities that worsens with prolonged standing and RELIEVED WITH ELEVATION you see brawny edema (skin is thick and leathery with brown pigment)/ non-pitting edema

Tell me about arterial insufficiency

this is insufficient blood supply to an area causing ischemia risk factors are atherosclerosis or diabetes characteristics are deep muscle pain in the legs that(intermittent claudication) is relieved with rest and dangling legs you will see skin that is cool to touch, pallor that worsens with limb elevation, and skin is shiny and thin

Brawny edema

this is local only and its characterized by thick skin and skin discoloration this is a sign of a venous condition

S2 sound

this is the dub this is the pulmonic and aortic valve closing

S1 sound

this is the lub this is the tricuspid and mitral (bicuspid) valve closing

Compare these assessment questions to the 8 critical characteristics learned earlier "When did the pain start?"

timing

Is the following statement true or false? Cardiac output refers to the amount of blood pumped by the heart with each beat.

true

Modifiable risk factors for cardiovascular dysfunction include cigarette smoking, diet, inactivity, and stress. FALSE TRUE

true

Prep U True or False: An electrocardiogram (ECG) uses 10 electrodes/leads to assess the heart's electrical activity from 12 different views.

true

There is evidence that women develop hypertension and cardiovascular disease later in life than men. FALSE TRUE

true

What should a patient's skin look like if they have good arterial circulation in the foot?

you want the skin to look like the person's skin color it should not be dull or a bluish color (cyanosis) the feet should feel warm, not cool check for capillary refill and pedal pulse

How would you know if a person has orthostatic hypotension?

well first, you would want to take their BP before and after position changes because orthostatic means change in position systole will decrease 25 or more diastole will decrease 10 or more heart rate will increase 10 or more

Subjective assessment questions to ask the patient (normal pattern)

what types of food to you eat? how often do you exercise?

Implementation methods for arterial insufficiency

with arterial insufficiency you want to dangle the legs to get blood from the heart to the legs